Psychosexual disorders Flashcards
What are the three types of sexual disorder?
disorders of sexual preference, gender identity disorders, sexual dysfunctions
What problems do you get in both male and female
Reduced libido, arousal difficulties, reaching orgasm too soon, failure to orgasm, dyspareunia
what is lack or loss of libido?
What are the different types
Lack or loss of sexual desire
• Lack of pleasure in anticipating, or reduced urge in engaging in, sexual activity
• Primary (always been absent) → secondary (declined) → situation (settings or partner) → OR total
Treatment for loss of sexual desire
Rx: treat primary cause (if found), couple therapy (relationship issues), graded individual exercises
Signs of sexual aversion or lack of sexual enjoyment
- Strong –ve feelings, fear or anxiety due to prospect of sexual interaction
- Active avoidance of sexual activity
- Lack of enjoyment → lack of pleasure, despite normal sexual responses + achievement of orgasm
- Can stem from rape/molestation
What is excessive sexual desire related to and what is the treatment
- Nymphomania (women)
- Satyriasis (men)
- Can be secondary to mood disorder (mania), early stages of dementia, learning disability, brain injury, SE drugs
- Rx: treat primary problem, CBT
Psychosexual problems specific to females, and which is most common
Failure of genital response
Orgasmic dysfunction (most common)
Non-organic vaginismus
Non-organic dyspareunia
what is failure of genital response in females and what is the treatment
- Usually due to vaginal dryness or lack of lubrication, psychological factors (anxiety), physical (infection), oestrogen def. (post-menopausal), secondary to lack/loss of sexual desire
- Rx → ↑ arousal levels, alleviate dryness (lubricant, oestrogen replacement)
What is orgasmic dysfunction in females and what is the treatment
- MOST COMMON sexual complain in women
- Delayed or doesn’t occur despite normal sexual arousal + excitement
- Primary → never had orgasm
- Secondary
- Situational
- Or total (all situations)
- Rx → specialist sex specialist referral, directed self-help programme (‘sensate focus’ for couples, kegel’s pelvic floor exercises…etc)
What is non-organic vaginismus
- Penetration impossible or painful due to blockage of vaginal opening (spasms of pelvic floor muscles)
- Related to anxiety + fearful thoughts (e.g. fear of penetration pain, previous sexual assault..etc)
Treatment non organic vaginismus
Rx o Vaginal examination → look for obstruction o Education (dispel myths about sex), relaxation techniques, strategies to achive penetration (kegel’s exercise, graded trainers [small → big]), involvement of partner…etc
What is non-organic dyspareunia
Pain during intercourse (superficial or deep)
Treatment for non-organic dyspareunia
o Exclude physical causes → infection, tender epiotomy scar, endometriosis, ovarian cyst
o Relaxation techniques (e.g. Kegel’s exercise)
DDx non-organic dyspareunia
+ treatment for this
PELVIC CONGESTION SYNDROME (if pain felt after intercourse) – a chronic medical condition in women caused by varicose veins in the lower abdomen - blood accumulation during arousal w/out orgasm (Rx: stimulate orgasm → e.g. vibrator)
Psychosexual problems specific to men
Erectile failure
Orgasmic dysfunction
Premature ejaculation
Non-orgasmic dyspareunia
What is erectile failure and what are contributing factors
- Inability to develop or maintain an erection, leading to failure of sexual intercourse
- Contributing factors: moral/religious views on sex/masturbation, previous –ve sexual experiences, performance anxiety, alcohol/drugs, stress, fatigue
Treatment of erectile failure
education (factors), self-help exercises, sildenafil (Viagra), papaverine or PG E1 (training on self-insertion), vacuum constriction device, surgical implant inflatable penis prosthesis
Orgasmic dysfunction men - what is it and treatment
- Inhibited ejaculation
- Rx: reduce performance anxiety, ↑ arousal + physical stimulation, addressing triggers/relationship problems/memories of past traumatic events…etc, education (dispel myths, effects of alcohol), sensate focus
What is premature ejaculation? What is the DDx?
What is the rx?
- Inability to control ejaculation adequately for both partners to enjoy the sexual interaction
- DDx → sexually inexperienced men, psychological stress, organic impairment (esp. pain), delayed erection
- Rx → education, reduce performance anxiety, self-help guides, exercises (‘stop-start’ technique and ‘squeeze’ technique), sensate focus
Non-orgasmic dyspareunia - men
Causes and treatment
- Pain during intercourse in men
- Causes: physical (urethral infection, scarring secondary to STD, tight foreskin), psychological
- Rx: treat physical, treat psychological (reassurance, education, relaxation techniques)
Define transexualism
a disorder of gender identity characterised by the desire to live and be accepted as a member of the opposite sex (usually accompanied by a sense of discomfort w/ one’s anatomical sex)
Define sex
the anatomy of a person’s reproductive system + their secondary sexual characteristics
Define gender
personal awareness of one’s own gender based on internal awareness
Epidemiology of gender dysphoria
Male to female (MTF) > female to male (FTM)
